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31 Cards in this Set
- Front
- Back
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34. How does aldosterone affect heart failure? How can you combat this?
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a. Causes myocardial fibrosis, oxidative stress, vascular inflammation, endothelial dysfunction, and is prothrombotic
b. Combat through Sprinolactones |
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35. How does myocardial dysfunction activate the RAAS?
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a. Increased load on heart→ reduced systemic perfusion→ activation of RAAS, SNS, endothelins, cytokines→ ischemia/remodeling
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36. What does decreased renal perfusion lead to?
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a. Increase in the synthesis of renin →
b. Increase in angiotensin I+ACE→ angiotensin II c. Angiotensin II stimulates production of aldosterone |
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37. What does angiotensin II do to the cardiovascular system?
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a. Vasoconstrction→ increase in afterload→ HF
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38. How does spironolactone prevent HF?
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a. Decreases preload
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39. What do ANP/BNP cause?
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a. Vasodilation
b. Natiuresis |
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40. What does enodthelin cause?
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a. Vasoconstriction
b. Cell proliferation c. Negative inotropism |
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41. What is the anti-apoptotic event?
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a. gp130 cytokine receptor genes prevent ventricular decomposition from stress
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42. What should a workup for CHF include?
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a. H/P
b. BNP measure c. CXR d. ECG |
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43. What is the best way to assess CHF?
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a. Echo
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44. What is the pro/con of exercise testing and cardiac cath in CHF tx?
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a. Can provide a functional evaluation
b. No correlation to a decrease in mortality after tx |
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45. What are the indications for a thallium 201 stress test?
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a. HF of uncertain etiology
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46. What does a thallium 201 stress test do?
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a. Differentiates ischemic vs. nonischemic cardiomyopathies
b. Large rest defects vs. ischemic cardiomyopathy |
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47. What is the use of coronary arteriography with CT in CHF tx?
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a. Identifying angina pectoris
b. Detection of MI with thallium 201 c. HF of uncertain etiology d. Detect unexpected obstructive CAD |
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48. What does the heart release in response to CHF?
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a. hBNP
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49. What conditions are associated with high BNP levels?
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a. HF
LVH b. Cardiac inflammation c. Kawaski’s disease….. |
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50. When is BNP released?
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a. Released from ventricular myocardium during ventricular overload or stretch
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51. What effect does BNP have on RAAS?
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a. Decreases in renin, vasopressin and aldosterone
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52. What does BNP cause in CHF?
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a. Vasodilation
b. Sodium excretion c. Both beneficial d. Can be a good marker for recovery |
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53. What happens the natriuretic peptide system in decompensated CHF?
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a. It is overwhelmed by enodthelin, epinephrine, aldosterone, and angiotensin
b. VASOCONSTRCITON |
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54. What is step tx in CHF?
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a. Begin with ACEI+ B-blockers
b. Add spironolactone c. Add digitalis d. 2-4 weeks between steps |
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55. What are the main causes of mortality in HF?
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a. Arrhythmias
b. Pump failure |
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56. What is the tx for pump failure in CHF?
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a. Nesiritide
b. Increases diuresis and natiuresis c. Decreases preload and afterload d. Decrease in aldosterone, enodthelin |
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57. What is the course of use of nesiritide in CHF?
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a. Bridging tx to next step
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58. What are the indications for nesiritide tx?
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a. Acute decompensated HF w/o cardiogenic shock or systemic hypoperfusion
b. Pump failure c. Septic shock with impaired O2 delivery d. Post-cardiac sugery |
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59. What are the contraindications for nesiritide?
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a. Diastolic dysfunction
b. Aortic stenosis c. Obstructive hypertrophic cardiomyopathy d. Pericardial tamponade e. Volume depletion |
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60. What causes delayed ventricular activation in CHF?
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a. LBBB
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61. How do you correct delayed ventricular activation in CHF?
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a. Biventricular pacing using resynchronous pacing
b. Can help to remodel |
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62. What is the strongest independent predictor of mortality in CHF?
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a. Left ventricular EF
b. <40%=7x risk of cardiovascular death c. 15x risk of sudden cardiac death |
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63. How is coronary reperfusion achieved in HF?
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a. Balloon angioplasty
b. Salvage myocardium, improve survival |
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64. What is the goal of surgical t of HF?
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a. Preserve native heart function
b. Assist or replace heart function |
